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1Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA

2Department of Radiology, Baylor College of Medicine, Houston, Texas, USA

Correspondence to Dr Peter Kan, peter.kan{at}bcm.edu

Summary

We report an unusual case in which physiologic neck rotation impeded perfusion through the internal carotid artery. The patient had a history of prior radical neck surgery and radiation for malignancy. He presented withbow hunter’s-like symptoms with transient loss of consciousness and right-sided weakness with left lateral neck rotation. A self-expanding peripheral stent was successfully used to treat the patient by preventing rotatory carotid compression. In select patients with prior neck surgery and radiation, carotid injections should be part of a dynamic cerebral angiogram if the vertebral arteries are unremarkable.

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